Protocol: A multi-modal, physician-centered intervention to improve guideline-concordant prostate cancer imaging.
Protocol: A multi-modal, physician-centered intervention to improve guideline-concordant prostate cancer imaging.
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方案：一个多模式，以医生为中心的干预，以提高指南一致的前列腺癌成像。
DOI：
10.1186/s13063-021-05645-3
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发表时间：
2021-10-18
期刊：
影响因子：
2.5
通讯作者：
Sherman SE
中科院分区：
文献类型：
--
作者：
Makarov DV;Ciprut S;Kelly M;Walter D;Shedlin MG;Braithwaite RS;Tenner CT;Gold HT;Zeliadt S;Sherman SE
几乎一半患有局限性前列腺癌的退伍军人接受了不适当的、浪费的分期成像。我们的团队探索了符合指南的前列腺癌成像的障碍和促进者，发现(1)新诊断的前列腺癌患者几乎不关心放射学分期，而是专注于治疗；(2)医生信任成像指南，但容易遵循自己的直觉，害怕法医学后果，并屈服于热衷于成像的同事的影响。我们使用一种基于理论的方法来设计一种多层次干预策略，以促进指南一致的成像对前列腺癌的分期。我们设计了前列腺癌成像管理(PCIS)干预：一项多点、阶梯式楔形、整群随机试验，以确定以医生为中心的行为干预对退伍军人健康管理局(VHA)前列腺癌成像使用的影响。多层次干预是根据理论领域框架(TDF)和行为改变轮开发的，将传统的医生行为改变方法与新的沟通和数据收集方法相结合。干预措施由三部分组成：(1)向临床医生及其网站提供的审计和反馈系统，告知个人临床医生和他们的网站他们的行为与同行的行为和已公布的指南相比如何；(2)学术详细计划，目的是教育提供者前列腺癌成像；以及(3)CPRS临床订单检查，以发现潜在的指南不一致的成像订单。干预措施将引入10个参与地理分布的研究地点。这项研究是对实施科学的重大贡献，为VHA提供了一个机会，以基于理论的方法确保以最低成本提供高质量的医疗服务。这项研究正在进行中。初步数据收集和征聘工作已经开始；尚未进行分析。临床试验.gov NCT03445559。预期于2018年2月26日注册
Almost half of Veterans with localized prostate cancer receive inappropriate, wasteful staging imaging. Our team has explored the barriers and facilitators of guideline-concordant prostate cancer imaging and found that (1) patients with newly diagnosed prostate cancer have little concern for radiographic staging but rather focus on treatment and (2) physicians trust imaging guidelines but are apt to follow their own intuition, fear medico-legal consequences, and succumb to influence from imaging-avid colleagues. We used a theory-based approach to design a multi-level intervention strategy to promote guideline-concordant imaging to stage incident prostate cancer. We designed the Prostate Cancer Imaging Stewardship (PCIS) intervention: a multi-site, stepped wedge, cluster-randomized trial to determine the effect of a physician-focused behavioral intervention on Veterans Health Administration (VHA) prostate cancer imaging use. The multi-level intervention, developed according to the Theoretical Domains Framework (TDF) and Behavior Change Wheel, combines traditional physician behavior change methods with novel methods of communication and data collection. The intervention consists of three components: (1) a system of audit and feedback to clinicians informing individual clinicians and their sites about how their behavior compares to their peers’ and to published guidelines, (2) a program of academic detailing with the goal to educate providers about prostate cancer imaging, and (3) a CPRS Clinical Order Check for potentially guideline-discordant imaging orders. The intervention will be introduced to 10 participating geographically distributed study sites. This study is a significant contribution to implementation science, providing VHA an opportunity to ensure delivery of high-quality care at the lowest cost using a theory-based approach. The study is ongoing. Preliminary data collection and recruitment have started; analysis has yet to be performed. CliniclTrials.gov NCT03445559. Prospectively registered on February 26, 2018
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
6.6
作者：
Makarov, Danil V.;Desai, Rani A.;Gross, Cary P.
通讯作者：
Gross, Cary P.
DOI：
10.1093/jnci/djt175
发表时间：
2013-09-04
期刊：
Journal of the National Cancer Institute
影响因子：
--
作者：
Makarov DV;Loeb S;Ulmert D;Drevin L;Lambe M;Stattin P
通讯作者：
Stattin P
DOI：
10.1023/b:mhsr.0000024351.12294.65
发表时间：
2004-06-01
期刊：
Mental health services research
影响因子：
--
作者：
Aarons, Gregory A
通讯作者：
Aarons, Gregory A
影响因子：
2.2
作者：
Hussey, Michael A.;Hughes, James P.
通讯作者：
Hughes, James P.